Chapters 1, 11, 12,
13 and 14
Radiation History
FYI

Detection is one of
the most important
uses of a dental
radiographs. With
radiographs we can
detect disease and
decay without clinical
symptoms.
History of X-rays

Wilhelm Conrad
Roentgen ( Ren-ken )
 Bavarian
Physicist
 Discovered x-rays
November 8, 1895
 Changed medical and
dental field forever
 Practiced on his wife’s
hand
History Cont….

Otto Walkhoff
 German
dentist
 Made first dental
radiograph that was
exposed for 25 mins. (
now it’s 1/10 of a sec.)
History Cont…

C. Edmund Kells
 Dentist
from New Orleans
 First to use x-rays for dental purposes in 1896
 Used his hands to place and hold films, which
led to the development of cancer to his hands.
 He later lost his fingers, then hand and arm.
 He also was the first dentist to hire an
assistant.
The importance of Dental X-rays
Diagnostic purposes
 Oral exams are limited
 Conditions can be detected in x-rays that
are unseen by the eye. X-rays contain
more information than a written record or
chart. Past x-rays help in future diagnosis,
and are always taken to benefit the
patient.

Benefit of Dental Radiographs
Detection of disease – primary benefit
 Benefit of disease detection far outweighs
the risk of small doses of radiation,
especially with today's dosages.
 Minimizes pain and expense- by early
detection abnormalities can be corrected
before they become too involved.
(prevention).

Uses of Dental x-rays


Many conditions do
not produce
symptoms, they are
asymptomatic.
Radiographs can
detect conditions
before they are felt by
the patient.
Information found on x-rays
include:
Missing teeth
 Extra teeth
 Impacted teeth
 Dental caries
 Periodontal disease
 Tooth abnormalities

Information found cont…
Retained roots
 Cysts and tumors
 Lesions
 Disease
 Routine procedures / RCT measurements

Information cont…..
Monitor growth and development of bone
 Monitor eruption and exfoliations of the
teeth
 Trauma

Who is classified as a Dental
Radiographer?




Any person who positions, exposes and
processes dental x-ray.
Dental assistant and Hygienist, sometimes the
doctor.
Must understand responsibility.
Must have technical skills / patient management
skills- patient will usually ask you question about
radiation safety vs. the doctor.
Who’s classified cont…..
Must be licensure ( state to state ).
 Must gain patients trust.

Duties and Responsibilities
Place, expose, process and mount x-raysyou cannot diagnose. You can look at the
x-rays, but you cannot tell the patient what
you see even if they ask.
 Patient education- explain importance of
x-rays.
 Be fast and good at taking them.

Duties Cont..
Dark room maintenance- being aware of
the age of the chemicals / the last time
they were changed or replenished. Check
the rollers and clean them as required.
 Maintain equipment, quality control, and
inventory- running test films thru the
processor, cleaning rollers and chemicals,
checking radiation levels of x-ray heads.

Professional Goals


ALARA principle- As Low As Reasonably
Achievable.
Patient Protection- should be your top priority
and concern.
 Thyroid
collar- flexible lead shield placed securely
around the patients neck.
 Lead apron- protects reproductive organs and blood
forming tissues from scattered radiation.
Professional Goals cont…
Lead apron must be( disinfected ) sprayed
of wiped down between each patient.
 Fast film- F- speed is the fastest.
 Film holding devices- ensures more
precise radiographs.
 Exposure time- limits exposure to the
patient.

Goals cont..
Infection control – proper sterilization of
the XCP equipment.
 Patient comfort- as best as possible
 Diagnostic

Operator Protection- You
Avoid primary beam- travels in a straight
line
 Safe distance away- 6ft. Away or 90 – 135
degree angle from the primary beam.
Stand perpendicular to primary beam 90
degrees.

Protection cont…

Docimeter Badge- also called a film
badge. Warn at waist level when ever
your exposing radiographs. Never wear
when you are being x-rayed or outdoors.
Operator Competence
Continuing education
 Books
 Journals
 Updated Techniques

Interpersonal Skills
Establish trust / build a rapport
 Bedside manner / Chairside manner
 Good skills promote patient confidence
 As important as technical skills
 Listening skills

Effective Communication

Verbal:



Choice of words is
extremely important
Verbal communication can
create confusion and
misunderstand pain,
discomfort, etc..
Tone of voice is crucial, not
rushed or tense, not loud or
excited.

Non – Verbal


Body language (posture,
body movement, facial,
expressions) make sure
your nonverbal and verbal
communications are
consistent. (nodding head )
Use good eye contact –
displays confidence
Communication cont…

Nonverbal and verbal
communication go
hand in hand.
 “It’s
nice to see you”
then smile.
 Facial expressions
and posture help in the
believability of a
conversation.

Listening skills
 Receive
and
understand the
message.
 Don’t interrupt, correct,
or finish their
sentences
 Listen between the
lines
Facilitation skills
Facilitation means the act of making easier
 Reduce worry and psychological stress
 Build patients trust
 Encourage questions
 Answer questions
 Say and do

First impressions

Appearance
(entire office)

The assistants personal
appearance, the front
office, the operatories
cleanliness and order
(never eat, drink, or chew
gum while working with
patients) check your
breath!!

Greetings

Be professional. Greet
patients by their proper
name like Mr. Brown
unless you have been
invited to call him George.
Introduce yourself if they
don’t already know you and
explain to them where you
are taking them and why.
Chairside Manner


The way a dental
professional conducts
themselves at the
patient’s chairside.
Avoid comments like
oops, cursing, put downs,
or other inappropriate
comments, or indicates a
lack of control.


Always be professional,
patients are here for
treatment and not to
become your best friend.
Educate as you go –
explain your position
within the office as well
as other staff members.
Manners. Cont..


Avoid personal questions
– you may open up a can
of worms.
Do not offer personal
information – you will be
working with a number of
different personalities,
you don’t want to become
the next dear Abby in a
dental office.


Keep up conversation –
especially when the
dentist is running late.
Instill credibility and
confidence
Attitude and Patient Relationships



Position of your body
– how you carry
yourself, your tone of
voice are all indicative
of your mood
Show courtesy
Be aware of patient
phobias


Be patient with
difficult patients, they
are usually scared
and in pain.
Be honest – some
procedures are
uncomfortable
(palatal anesthesia
feels like a bee sting)
Patient Education and the Dental
Radiographer

Patient knowledge
and acceptance
comes from you!
 Realize
benefits
 Get them to accept the
prescribed treatment
 Follow prevention
plans
 Decrease
their fears
 Increase their
motivation for regular
treatments
 Explain to the patient
why dental
radiographs are
important, and how
they are used to
benefit them
Methods of Patient Education
Oral presentation
 Printed literature – in the form of
brochures, newspaper, or magazine
articles saved.
 The x-ray itself – use it as a guide to show
everything that can be seen and why it is
important in preventive and corrective
dentistry.

Legal Issues And The Dental
Radiographer

Laws govern
equipment, ionizing
radiation and the
people taking
radiographs.

Federal and State
Regulations
 Consumer-Patient
Radiation Health and
Safety Act (RHS) –
(federal law)
 Outlines requirements
for safe use of x-ray
equipment
Legal Issues cont…



Maintenance of x-ray
equipment
Requires certification of
the dental radiographer
State laws

Require inspections of
dental x-ray equipment on
a regular basis

Licensure Requirements


State laws regulate the
exposure of dental
radiographs
Other requirements maybe:
Radiology certifications,
exposing film under direct
supervision and following
restrictions concerning
types of radiographs that
may legally exposed
Risk Management (Prevention)



Refers to the policies and procedures that
should be followed by the dental radiographer to
reduce the chances that a patient will file legal
action against the dental radiographer or the
supervising dentist.
Lawsuits prevention
Self determination – Patients have the legal right
to make choices about the care they receive.
Can give consent or refuse treatment.
Disclosure


The process of
informing the patient
about the particulars
of exposing
radiographs
Discuss diagnosis
and treatment with
patient

Be sure patient
understands PARQ!
 Purpose
and benefit of
the x-rays
 Assistant will take
x-rays
 Amount and type of
x-rays to be exposed
Disclosure cont….
 The
harm if x-rays are
not taken
 Risks associated with
x-ray exposure
 Alternatives


Dr. and Assistant
should be involved in
disclosure
Must have informed
consent from all
patients whether it is
written or verbal
Disclosure cont…



Legal guardian for
patients under 18 or
in competent adult
Do Not misrepresent
any disclosure
information
Do not threaten
patient into disclosure
Legal Issues cont…

PARQ


Procedures, Alternatives,
Risk, Questions
Can be written in the chart
as a symbol of informed
consent

Responsibility



The Dr. is responsible for
performance of the
Assistant
The DA is responsible for
their own actions also
Dentist are legally
accountable or liable to
supervise the performance
of the dental assistants and
their own actions as well
Legal Issues cont…


Malpractice – when
the dental practitioner
is negligent in the
delivery of dental care
Negligence – when
the dental treatment
or diagnosis may fall
below the standard of
care

Standard of Care –
Overall quality of care
that is provided by the
dental practitioner
Legal Issues cont….

Statute of Limitations
 Time
period in which
to bring a lawsuit or
malpractice action
 Begins when the
patient discovers that
and injury has
occurred as a result of
dental negligence
Legal Issues cont…..

Patient Records
 Every
patient must
have a dental record
which includes
documentation of the
exposure of dental
radiographs and also
include:




Informed consent
Number and type of
radiographs exposed
Reason for
radiographs
Diagnostic
information obtain
from x-rays
Legal Issues cont….
Entries in dental record should never be
erased
 If an error is made it should be lined threw
and dated with the initials of the person
that is correcting it

Confidentiality
All information is confidential
 Non–privileged persons have no access
 Can not discuss treatment with another
patient or staff member that is not involved
in the treatment

Confidentiality
All information is confidential
 Non–privileged persons have no access
 Can not discuss treatment with another
patient or staff member that is not involved
in the treatment

Ownership of X-rays / Records
The Dentist is the owner
 Reasonable access to records must be
granted to patient (copies, duplicates of xrays)
 Originals should always stay in the office
 X-rays and records are retain indefinitely
 Store in a safe place

The End!